Effectiveness of deep dry needling versus manual therapy in the treatment of myofascial temporomandibular disorders: a systematic review and network meta-analysis.

IF 2 4区医学 Q2 REHABILITATION Chiropractic & Manual Therapies Pub Date : 2023-11-03 DOI:10.1186/s12998-023-00489-x

Ángela Menéndez-Torre, Aitor Martín Pintado-Zugasti, Juan Nicolás Cuenca Zaldivar, Paula García-Bermejo, Diego Gómez-Costa, Miguel Molina-Álvarez, Alberto Arribas-Romano, Josué Fernández-Carnero

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Abstract

Background: Temporomandibular disorders (TMDs) are the most common cause of orofacial pain of non-dental origin, with approximately 42% of diagnoses corresponding to myofascial pain. Manual therapy and dry needling are commonly used interventions for the treatment of myofascial temporomandibular disorders. However, it is unclear whether one of them could be superior to the other.

Objectives: The aim of the present systematic review and network meta-analysis was to compare the effectiveness of manual therapy and dry needling in patients with myofascial TMD.

Methods: This is a systematic review and network meta-analysis. Randomized clinical trials were searched in the databases of Pubmed, PEDro, CINAHL, Web of Science, Scopus, Cochrane, Google Academic and EMBASE. The methodological quality of studies included in this review was judged using the Physiotherapy Evidence Database (PEDro) scale. A frequentist network meta-analysis was carried out, assuming random effects, to estimate the effects of interventions for temporomandibular joint pain measured on a 10-point visual analogue scale.

Results: Out of 3190 records identified, 17 met the inclusion criteria for qualitative analysis and eight were included in the network meta-analysis. Indirect comparisons between dry needling and manual therapy showed no significant differences in their effects on pain reduction (Odds Ratio [95%CI]; - 0.263 [- 1.517, 0.992]). The ranking of treatments shows that manual therapy (SUCRA = 0.932) followed by deep dry needling (SUCRA = 0.775) present the highest values of estimation and can be considered the most likely to reduce pain.

Conclusions: The results of the network meta-analysis should be considered with caution due to the low quality of the evidence available and the high variability of the study protocols in terms of the method of application of dry needling and manual therapy interventions. PROSPERO under identifier: (CRD42020186470).

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深干针与手法治疗颞下颌肌筋膜紊乱病的疗效：一项系统综述和网络荟萃分析。

背景：颞下颌关节紊乱病（TMDs）是非牙源性口面疼痛最常见的原因，约42%的诊断与肌筋膜疼痛有关。手法治疗和干刺是治疗颞下颌肌筋膜紊乱病的常用干预措施。然而，目前尚不清楚其中一个是否会优于另一个。目的：本系统综述和网络荟萃分析的目的是比较手法治疗和干针治疗肌筋膜TMD的有效性。随机临床试验在Pubmed、PEDro、CINAHL、Web of Science、Scopus、Cochrane、Google Academic和EMBASE的数据库中进行搜索。本综述中研究的方法学质量使用物理治疗证据数据库（PEDro）量表进行判断。在假设随机效应的情况下，进行了频率学家网络荟萃分析，以估计干预措施对颞下颌关节疼痛的影响，该影响在10点视觉模拟量表上测量。结果：在确定的3190份记录中，17份符合定性分析的纳入标准，8份纳入网络荟萃分析。干针和手法治疗之间的间接比较显示，它们在减轻疼痛方面的效果没有显著差异（比值比[95%CI]；-0.263[-1.517，0.992]） = 0.932），然后进行深层干针（SUCRA = 0.775）呈现最高的估计值，并且可以被认为是最有可能减轻疼痛的。结论：应谨慎考虑网络荟萃分析的结果，因为现有证据的质量较低，研究方案在干针和手动治疗干预的应用方法方面具有高度可变性。PROSPERO的标识符为：（CRD42020186470）。

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来源期刊

Chiropractic & Manual Therapies Medicine-Complementary and Alternative Medicine

CiteScore

3.20

自引率

15.80%

发文量

审稿时长

20 weeks

期刊介绍： Chiropractic & Manual Therapies publishes manuscripts on all aspects of evidence-based information that is clinically relevant to chiropractors, manual therapists and related health care professionals. Chiropractic & Manual Therapies is an open access journal that aims to provide chiropractors, manual therapists and related health professionals with clinically relevant, evidence-based information. Chiropractic and other manual therapies share a relatively broad diagnostic practice and treatment scope, emphasizing the structure and function of the body''s musculoskeletal framework (especially the spine). The practices of chiropractic and manual therapies are closely associated with treatments including manipulation, which is a key intervention. The range of services provided can also include massage, mobilisation, physical therapies, dry needling, lifestyle and dietary counselling, plus a variety of other associated therapeutic and rehabilitation approaches. Chiropractic & Manual Therapies continues to serve as a critical resource in this field, and as an open access publication, is more readily available to practitioners, researchers and clinicians worldwide.